Baseball and quackery

I’m sitting here watching my favorite baseball team lose the Pennant, but it’s been a good season and when they finish losing tonight, I’ll still be proud of them. There’s one player in particular who I really like despite the fact that they’ve had to send him down to the minors for a little tune up (and others I’d rather were forced to wear an electronic collar that won’t let them leave Toledo).

And unless your a Yankees fan, baseball isn’t just about the wins. But with the large number of games, it is about hope. Even with a losing team, people often form a bond of affection and hope that is not entirely rational. There’s an element of variable reinforcement, but it’s not just playing the slots.

We see this in people who seek out so-called alternative medicine. It is objective fact that, for example, homeopathy is a scam based on an incorrect understanding of science, and that acupuncture is an ineffective practice based on the imaginings of people who have forgotten (or never learned) basic biology and physics. The studies on these and other dubious practices are clear: occasional “positive” studies are overwhelmed by those that show no improvement over placebo. They are no different from other forms of faith healing.

But faith healers, at least the ones who aren’t consciously plucking the pigeons, succeed from time to time. If enough feverish malaria patients come to the tent, some of them will walk out feeling better. That’s the natural course of the disease. I’d love to take credit for fixing my patients’ low back pain or colds: they almost always get better after seeing me, but they would probably have gotten better if they hadn’t (my role, aside from passing out grandmotherly advice is to make sure the back pain or the cold are really what they appear and not myeloma or pneumonia).

But I can’t and won’t claim credit for such “cures”. Some might, but it’s not my style. I prefer to keep it honest and above-board with my patients. Some of the things I do might seem miraculous (like preventing heart attacks) but it’s all just applying science to people.

Those who promote various forms of quackery, whether on late night infomercials or in “real” doctors’ offices, cross that line: they take credit for nature’s own actions, and dress it up to make it look good. It may seem “science-y” to have a hormone replacement program designed just for you, and the doctor may really listen and care about your well-being, but when he writes the prescriptions for the various hormone potions, he hasn’t done you any favors. He’s simply used a faulty understanding of natural variability and a puffed up sense of his own abilities to understand science, and gone against all the relevant scientific literature. It’s theater. Maybe it’s well-meaning theater, but it’s no more than that at best.

But patients form an attachment to various health interventions, legitimate and otherwise. No matter what I or a Vodun healer might do, it comes with ritual, and sometimes the patient feels better, sometimes worse. If they like us, then we get the credit (and often fail to get the blame when they don’t).

In a sense, quacks can succeed not primarily because of a societal failure in education, but because of the failure of our medical system to provide Care. I think this is exaggerated, as most doctors do care and their patients know it, but when you work with science as your guide, answers aren’t always pretty (“No, I cannot cure your liver cancer.”).

Quackery, without the restraint of science or the ethics of medicine can promise the impossible. It can promise to stop the common cold, to cure the incurable cancer. And if the practitioner is kind enough, the result is less relevant.

Real doctors can help guide people away from fake treatments by showing ongoing care, but sticking with the incurable. It’s tempting to ask oneself, “Why would someone bother to come to me with a simple cold?” but the answer is obvious: they want to feel cared for. We can provide that, and better than the quacks. We can give good, common-sense advice, and let them know that it’s going to get better.

Baseball fans (and normal people) can lose the Pennant race and still look forward to the next season, but woe unto the person who tells them their team will always lose. People know that it’s simply untrue. Sometimes a bad ball team pulls off the seemingly impossible. Sometimes a cancer spontaneously regresses. There is always room for hope, tempered by reality.

2 Comments

“Even with a losing team, people often form a bond of affection and hope that is not entirely rational.”

Maybe it’s not rational, but it’s certainly common. Losing teams are like betting on the long shot in horse racing, or buying a lottery ticket when the pot goes above $100 million. The expense is nominal, and the payoff is wonderful. No one who understands the least bit of mathematics thinks he really has a chance, but there’s always hope.

As a long time Phillies fan (as in, I remember the 1964 season), I’m used to that idea.

I think there are a couple of things that make people gravitate toward alternative medicine that don’t necessarily translate to being a baseball fan, though. One is that, at least as it’s practiced in America, real medicine isn’t terribly good at listening to people. An acquaintance of mine has chronic pain brought on by some injuries, and feels as though she’s often treated as a hysterical woman. She’s into the whole acupuncture and holistic medicine thing now, and there’s no arguing her out of it because the sort of retail medicine one gets here doesn’t work for her. The other is the hideous expense and resultant non-availability of long term care.

So, yes, there are some human foibles that make alt med. attractive, but there are some things real medicine could do to help itself, too.

saffronrose

For some reason, no matter how often it is explained to her, my MiL seems to think that if a cold is bad enough, or goes on for two weeks or more, one should go to the doctor, when the sufferer knows darned well from symptoms that it’s not anything requiring anti-biotics. Drives me bonkers–but other than that, we get along fine, which is good: we live together.

I had one psychiatrist who would not listen when I said, I’m an insomniac who’s depressed, not a depressed person having problems sleeping. When I’d say, it’s keeping me awake, sleep meds do that to me, he’d increase the dosage of Serzone, which is thankfully off the market now. He never *looked* at me in session, and I gather he had “don’t confuse me with facts” and “I know more than you about your body” attitudes. After a week of my knees buckling because my body was so tired, I’d had enough and fired him. I must say, though, that the pdocs in the study I participated in for the better part of six months (rTMS device), and the one I hired afterwards, in 2001, have more than made up for that. The study leads were wonderful, and of course it was their job to listen to study participants, but they always made us feel truly worthwhile. Once I was dx’d as bipolar, on the same day my son was given the same dx, I had a better feeling of what to look for in a pdoc, for myself. Dr. T (doesn’t play piano, only has the usual complement of fingers) has made such a difference in my life, and appreciates the fact that I do my own research, and ask for her take as well, and that I do ask questions and weigh answers, unlike most of her patients. I’m still seeing her, 10 years later.

My early onset bipolar (talk about another dx that is controversial) son’s county-supplied psychiatrist went on and on about nutrition and getting a treadmill or exercise bike, for which I said repeatedly we had no room for. I swear she did her best to push my son’s buttons and send him into a meltdown, and she never said anything good about his progress without then launching into another lecture about his eating and activity. Let’s see, he was on lithium, depakote for a while, seroquel, and now (no thanks to her) on zoloft, abilify, and lamictal, which are less weight-positive. Excuse me? The first three are known for putting weight on/increasing appetite/early onset of Diabetes II, with a possible later increase to insulin-dependence. Getting him on the drug regimen that would actually take care of his mood swings and pervasive depression? Veeerrrrrry slow. At one point, when he’d made such great progress at school, and she had still had something negative to say, I’d had enough, and finally did what I should have done much earlier: checked the insurance list for in-network child/adolescent pdocs. At one point, five other professionals, in addition to me, had to press for an anti-depressant to be added to his regimen. With the new, private, child to adult pdoc, three months of visits did more for him than the years of visits with her.

Friday, we went to a ped. GE, because he’d been having stomach pains and vomiting for two weeks, with him sent home early two days, and missing two days entirely. As it was, the afternoon before, he was feeling much better, but we kept the appointment. The man hadn’t consulted the chart before he entered, so he looked at my son and asked him his name–not the greatest start. Once he had ruled out any serious issues, he begins lecturing my son on (yup) diet and exercise. A never got to finish a sentence, nor were any of either of our comments or answers affecting what he said. He talked about his own son, who has entirely different issues from A, and told me to take away ALL his screen time during the week, and only let him have one hour of that on the weekends–including movies, which, as you know, take longer than that. He made completely inaccurate assumptions about A’d activity and eating habits. A kept his temper, and I remained civil. Once we left, we began to discuss what had happened, the extremes used, the not-listening, and general lecturing out of his specialty. We also discussed what was reasonable for him to do, given that he seldom sits at a desk or a screen the entire day with no exercise in between. Food, we’re working on: portion control and appropriate choices.